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05/18/2001 15:42 2094671118 AGE STM<TON PAGE 02 <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> UQ Project _ Q \ IVr)oYt,y <br /> Locatiao: Z 1 6�7 -R� 1 `e�, ,2l ; 01cl , A cg n Ery C Ed <br /> County:,S,.,. �6 ,x 1I.. < CorrNumber.------ <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> Water Well Drillers Reports which are on file in your office. <br /> In accardance with the requirements of Section 13752 of the Water Code, it is stipulated and agreed that such <br /> reports, or any copy or copies made thereof, will not be made available for itrspection by the public but will <br /> be used solely by this governmental aoeney for making studies. If copies are made or taken, each copy wiH <br /> be stamped"CONFIDFNTIAL."or"FOR OFFICE USE ONLY"and will be kept in a restricted file, access <br /> to\\hick is limited to The staff of this governmental agency or to its contracted agents. Any copies furnished <br /> to contracted agents must be returned to the Department of)Vater Resources, Central District upon completion <br /> of work by the contracted agent. <br /> No information crnnained in these reports can be dissemiriated or published without the written permission of <br /> the owner of the Well. <br /> Contracted Agent Govenunental Agency <br /> < VWA3 )Ltt9� 3Q t( s,� a),6 4 t t,a,,. - <br /> Address Address <br /> S�os 4 t A UA C�5 It <br /> City,State, &Zip Code City,State,Zip Code <br /> By Q& ,J <br /> Officer OT46cr <br /> Title Title <br /> Telephone Telepbone <br /> (tor P•p,nmap•t blr m tion coptea Mat, ) <br />